Barry Meisenberg, MD, chair for quality improvement and healthcare systems research, recently submitted a letter to the editor to the New York Times regarding “Treatment Cost Could Influence Doctors’ Advice” article (April 18, 2014). His letter was published in the April 27, 2014 New York Times–continuing the dialogue on Choosing Wisely. Read his letter here.

Less than two years after opening, the Weight Loss & Metabolic Surgery Program at Anne Arundel Medical Center (AAMC) recently became a Level 1 Facility, nationally accredited by the American College of Surgeons for providing high quality care and excellent outcomes. The Level 1 designation also means AAMC is a high volume center performing more weight loss operations than the average bariatric surgery center in the U.S. In the first year of AAMC’s program, led by renowned bariatric surgeon Alex Gandsas, MD, nearly 300 surgeries were performed including sleeve gastrectomy, gastric bypass, and gastric lapband surgery. The program started in July 2012, and since then, more than 450 weight loss surgeries have been performed. >>More

The FDA recently issued an advisory strongly discouraging the use of uterine power morcellators. Read the MedPage article with the advisory and ACOG comment here. The FDA’s specific recommendation to physicians is highlighted. Leading hospitals around the country are taking either of two approaches: banning use of the morcellator or having its use restricted to within bags in the abdomen to protect against the risk of spread of potentially malignant tissue. This controversy was the subject of our February Women and Children’s M&M Conference.

Since that discussion efforts have been made to assure that we have the necessary high quality surgical bags, and we do. The use of the power morcellator, the incidence of leiomyosarcoma, and the impact of surgical technique on survival are each of some small increment. Balanced against that risk is the benefit of the decreased morbidity of the minimally invasive techniques allowed by the use of morcellation. More informed high level conversation is coming from national medical thought leaders, including ACOG.

With that expectation, having seen different responses at other hospitals, and having gotten differing opinions within our service, at this time I see the prudent action to be the more conservative one of requiring the use of collection bags to isolate the tissue from spread within the abdomen at time of morcellation.

Further, the FDA’s discussion points (highlighted in yellow within the attachment) should be considered as imperatives in any pre-operative discussion where morcellation may be a possibility. And that should be documented.

Due to the small number of patients impacted by this controversy, the potential for stirring up fear and worry and the fact that we are simply responding to published recommendations, I do not view this as something justifying increased local publicity. It is a subject you should be familiar with, expect questions about and be able to discuss in an informed manner. If contacted by a reporter, the best response is to refer them to the AAMC PR department for comment.

Seventy percent of acute coronary syndrome deaths occur outside of the hospital. As an accredited chest pain center, AAMC’s heart team needs your help in educating the public on the importance of calling 911 for suspected heart attack symptoms. Please do not let your patients or their family members drive to the Emergency Department. All local EMS have the ability to administer emergency medications and defibrillation if needed. EMS will transmit a 12-lead ECG directly to the hospital Emergency Department. Eighty-five percent of heart damage occurs within the first two hours of a heart attack. Early symptoms include chest pressure, squeezing or discomfort, anxiety, fatigue, shortness of breath, nausea, a feeling of fullness, and even back pain.

This year, AAMC clinicians provided flu vaccines to more than 2,500 community members through on-campus clinics and events out in the community. This means thousands of potential flu infections—and potential deaths from complications of flu—were prevented.

From Choosing Wisely®: For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), the American Gastroenterological Association recommends that long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals. The main identifiable risk associated with reducing or discontinuing acid suppression therapy is an increased symptom burden. It follows that the decision regarding the need for (and dosage of) maintenance therapy is driven by the impact of those residual symptoms on the patient’s quality of life rather than as a disease control measure. >>More

Our triennial Joint Commission survey occurred the week of November 18. The surveyors were overwhelmingly positive about what they saw and heard. They are taking several AAMC best practices back to the Joint Commission, and named AAMC a “role model” for other hospitals and health systems around the country – an incredible tribute to our employees and medical staff. Our survey results reflect the high-quality, safe care we provide to our patients daily. Thank you for your unending commitment to excellence in quality and safe patient care.

The Baltimore Business Journal recently noted AAMC as the third busiest hospital (measured by admissions) in the Baltimore region. In addition, we were noted for high quality in maternity care, surgery, and overall quality as rated by patients. Click here to read the article.